A retrospective analysis of data from illicit drug abuse cases in Beijing between 2018 and 2020.

The overall number of drug abuse cases has been on the rise around the world, causing it a disaster in many countries. In this retrospective study, we analyzed the characteristics of 11,903 drug abuse cases in Beijing, the capital of China, in the perspective of age, gender, nationality, region, season, type of specimens and various drugs, respectively. The case information was collected by the national-level forensic toxicology laboratory, which belongs to the China University of Political Science and Law. It was shown that the overall number of drug abuse cases had increased sharply from 2018 to 2019 and had a decrease of 25% in 2020. The incidence of drug abuse cases involving men was much higher than that of the cases involving women. The adolescents and young adults accounted for the largest share of drug abusers in our study. Haidian, as a national center of scientific and technological innovation with global influence, had the largest percentage of toxic substance-related cases, and the change was more pronounced than other districts during the 3-year-period. Chaoyang was second to Haidian in the number toxic substance-related cases. As a key window of economic, Chaoyang had the highest number of foreigner drug cases. June to August had the highest number of drug abuse cases, while amphetamines, opioids, cannabis and cocaine were the most common toxic substances involved in the cases we detected. To our knowledge, this is the first study to provide an overall analysis of drug abuse cases in Beijing, China. The study indicated the presence of a wide number of drug abuse cases in the capital city and confirmed the threat for the public safety and health. Such forensic information can assist the government to devise intelligence-based preventive and repressive measures and policies.

Case report: isolated pulmonary valve endocarditis in a 39-year-old patient with intravenous drug abuse.

BACKGROUND: Isolated pulmonary valve endocarditis is a very rare form of right-sided infective endocarditis. Due to the anatomy, in most cases, just the tricuspid valve is involved. Diagnosis can be challenging because of non-specific symptoms (fever, dyspnoea, haemoptysis, and pleuritic chest pain) and difficulty of detection by echocardiography. Risk factors include intravenous drug abuse, congenital heart disorders, alcohol abuse, male sex and central venous catheters, or pacemaker leads. CASE SUMMARY: A 39-year-old homeless male patient, who was a current intravenous drug user, presented with fever, dyspnoea, and haemoptysis. The chest X-ray showed bilateral infiltrates. Empiric antibiotic treatment was initiated. Blood cultures showed the presence of Streptococcus dysgalactiae. Atypical causes of pneumonia were excluded. Systemic embolism was suspected, and a computed tomography scan of brain, thorax, and abdomen was performed. Multiple septic embolic lesions were detected in both lungs. Echocardiography revealed an isolated pulmonary valve endocarditis. Penicillin G and gentamycin were administered intravenously for a duration of 6 and 2 weeks, respectively. The patient was discharged in stable condition but did not return for outpatient clinical appointments. DISCUSSION: To detect rare causes of right-sided infective endocarditis, repeated echocardiograms with special focus on the pulmonary valve may be required. Usually, antibiotic treatment alone leads to recovery. In special situations (heart failure, septic shock, or large vegetation size) surgery is required. Due to the high risk of postoperative complications, surgery in intravenous drug users should be avoided if possible.

Does high-dose benzodiazepine abuse really produce liver toxicity? Results from a series of 201 benzodiazepine monoabusers.

BACKGROUND: Several side-effects related to prolonged benzodiazepines (BZD) use have been reported. Given the primary role of liver in BZD metabolism, toxicity related to prolonged high-dose BZD use could be conceivable. No data are available on the long-term impact of high-dose BZD use on liver. RESEARCH DESIGN AND METHODS: A total of 201 BZD mono-abusers admitted to an Addiction Unit for detoxification were evaluated. Liver enzymes were evaluated at admission, before starting any treatment. An elevation of more than five times the upper limit of normal range (ULN) in serum ALT or conjugated bilirubin, or a combined elevation of AST, alkaline phosphatase and total bilirubin, one of which exceeding >2 the ULN, was considered diagnostic for drug-induced liver injury. RESULTS: None of the evaluated subjects showed significant alterations of liver enzymes. Those with the highest transaminase levels were showing high body mass index. Twenty patients (10%) showed elevated gamma-glutamyl-transferase. No alteration of alkaline phosphatase, nor bilirubin was found in any patient. The average dosage of BZD was 307 mg of diazepam-equivalents for 7 years. CONCLUSIONS: Present data suggest that prolonged use of high-dose BZD, although very dangerous for several reasons, does not seem to produce a significant drug-induced liver injury.

Satisfacción de los pacientes en tratamientos por abuso de sustancias y su relación con variables de las instituciones asistenciales / Clients' satisfaction with a substance abuse treatments and its relationship with the institution characteristics

La satisfacción que los pacientes tienen con respecto a sus tratamientos es un indicador de la calidad de los mismos y un importante predictor de sus posibles resultados. Se analizaron los niveles de tal satisfacción en una muestra de pacientes con problemáticas de abuso de sustancias, tratados en instituciones del Área Metropolitana de Buenos Aires (AMBA). Los grados de satisfacción fueron a su vez analizados en relación con las características diferenciales de las instituciones (tipo de institución, ubicación geográfica, género de los pacientes aceptados, presencia de cualidades atípicas en las instituciones) y la evolución de los tratamientos (duración y cantidad de interrupciones del proceso). A partir de un muestreo aleatorio por conglomerados y estratificado, se convocó una muestra de 216 participantes pertenecientes a 22 centros, que completaron un cuestionario de satisfacción, diseñado para este estudio. Los resultados mostraron niveles elevados de satisfacción en las distintas áreas exploradas, observando características distintivas de las instituciones asociadas a diferentes niveles de satisfacción, como es el caso del tipo de institución y el género de los participantes aceptados. No obstante, no se encontraron diferencias en los grados de satisfacción en función del tiempo de desarrollo del tratamiento y la cantidad de interrupciones del mismo. Los resultados obtenidos son discutidos en relación a los alcances del estudio, a la vez que se presentan sus limitaciones y se proponen futuras investigaciones para avanzar sobre esta temática.

The client satisfaction about his treatments it is an important indicator of its quality, but also a fundamental predictor of treatment outcome. Specifically, in patients with drug abuse disorders, the degrees of satisfaction with their treatments have presented lineal correlations with the amount of therapeutic change and the continuity in treatment (prevention of drop-out). Thus, the analysis of clients' satisfaction with their treatments is presented as an indirect and alternative strategy to analyze the effects of therapy for drug abuse disorders, a main health, social, and political problem in the world wide. In this exploratory study we analyzed the levels of satisfaction about their treatment in a sample of client's with substance abuse disorders, treated in institutions of the Buenos Aires Metropolitan Area (AMBA). Then we explored the relationship among the levels of satisfaction with the specific features of the institutions where the treatments were conducted (type of institution, geographic location, genre of the clients accepted, and the presence of atypical characteristics) and with characteristics of the evolution of those treatments (treatments length and amount of interruptions during the therapeutic process). Based on a stratified cluster random sampling strategy, using the above-described characteristics of the institutions analyzed in this study to create the clusters, we designed a sample of 216 subjects that were treated in 22 institutions with treatments subsidized by the Argentine National Secretary for the Prevention of Drug Abuse and the Fight against Drug Trafficking (SEDRONAR by its acronym in Spanish). All the participants of this research completed a questionnaire developed ad hoc and based on previous developments, to explore patient's levels of satisfaction in six areas: Admission, General environment (divided into the sub-areas Human and physical context and Mistreatment), Satisfaction with food, Staff evaluation (divided into the sub-areas Overall staff assessment and Specific staff assessment), Satisfaction with treatment (divided into the sub-areas Treatment features, Treatments results, and Complementary therapeutic devices), and General treatment evaluation. Results showed that there were same features of the institutions related to different levels of satisfaction in the participants of the study. Regarding the type of institution, patients of the psychiatric clinics presented the lowest degrees of satisfaction while the patients of the day hospitals had the highest levels of satisfaction. Also different levels of satisfactions were observed based on the genre of the patients accepted in the institutions. Patients of the institutions that only accept male clients have greater degrees of satisfaction than patients in mixed institutions. No significant differences were found in patient's satisfaction due to institution geographical location. Also, we have not found a significant association between patient's satisfaction and treatment length or between treatment satisfaction and amount of interruptions in the therapy. The results are discussed in the context of the scopes of the study, while further research is suggested to move forward in the exploration of this issue. The differences in satisfaction due to the type of institution might be explained by the degree of openness and flexibility of the setting, but also by the severity of the patients that are included in eacht type of institutions. As well, the differences in satisfaction based on the genre of the patients accepted by the institution could be explained by the predominance of male patients in the population (85%) and the possible lack of adaptation of treatment characteristics to female specific necessities. However, the results of this research must be interpreted extremely cautious because of limitations of the study related to the sample method and the unknown psychometric properties (in terms of validity and reliability) of the instrument used.

A Better Form of “Education on the Proper Use of Pharmaceutical Products” and “Drug-Abuse Resistance Education” in Junior High School Students and the Perspective of Educators with Different Types of Jobs / 社会薬学

<p>In junior high school, educators with many different types of specialty jobs are involved in “education on the proper use of pharmaceutical products” and “drug-abuse resistance education”. Examples of these different jobs are physical education teachers, school nurses, school pharmacists. The aim of this study was to elucidate novel ideas and new directions in the future of medicine instructional education by clarifying the aims and thoughts of educators with different jobs on the education of pharmaceutical medicines and drug use. Based on the technique of Personal Attitude Construct (PAC) analysis, junior high school staff members involved in “education on the proper use of pharmaceutical products” and “drug-abuse resistance education” were interviewed regarding their aims and thoughts. Their responses were analyzed qualitatively. Five school pharmacists, five school nurses, and four physical education teachers were interviewed. The responses revealed that school pharmacists engaged in student education from the specialized perspective of pharmacology, school nurses engaged in student education from the perspective of imminent situations, and physical education teachers engaged in student education more from the perspective of student environment. This study suggested that “education on the proper use of pharmaceutical products” and “drug-abuse resistance education” should be a collaborative effort, so there were the different perspectives and aims of educators with different specialty jobs in the instruction of junior high school students on these subjects.</p>

Gender differences in Afghan drug-abuse treatment: an assessment of treatment entry characteristics, dropout, and outcomes.

OBJECTIVE: The current study examines gender differences in drug-abuse treatment (DAT) entry, dropout, and outcomes in seven DAT centers in Afghanistan. This is the first study to examine gender differences in DAT programming in Afghanistan. DESIGN: A prospective cohort design of 504 women and men in seven DAT centers in Afghanistan was used in this study and the analyses examined whether gender differences exist for patients (1) at treatment entry, (2) at treatment dropout, and (3) for treatment outcomes. RESULTS: Gender differences were found at baseline for patient characteristics, drug use, crime, and social and occupational functioning. Results showed a trend that women remained in treatment longer than men. Looking at gender differences in treatment success, results showed greater reductions in drug use and crime, and greater social functioning among women. CONCLUSION: Results provide preliminary evidence for potential treatment success of women-tailored DAT programming in Afghanistan. Results also indicate that DAT appears to be successful among Afghan men; however, lower positive outcomes for men when compared to women suggest that more efforts should focus on tailoring DAT programming to the specific needs of Afghan men as well. Study limitations are addressed, and important policy implications are discussed.

Juvenile exposure to ketamine causes delayed emergence of EEG abnormalities during adulthood in mice.

BACKGROUND: Increased susceptibility to cognitive impairment or psychosis in adulthood is associated with adolescent drug abuse. Studies in adults have identified impairments in attention and memory, and changes in EEG, as common consequences of ketamine abuse. In contrast, the effects of ketamine on the juvenile brain have not been extensively tested. This is a significant omission, since abuse of ketamine is often observed within this age group. OBJECTIVES: Juvenile mice (4-6 weeks of age) were administered ketamine (20mg/kg) for 14 days. EEG was assessed in response to auditory stimulation both at one week following ketamine exposure at 7 weeks of age (juvenile) and again at 12 weeks of age (adult). EEG was analyzed for baseline activity, event-related power and event-related potentials (ERPs). RESULTS: While no effects of ketamine exposure were observed during the juvenile period, significant reductions in amplitude of the P20 ERP component and event-related gamma power were seen following ketamine when re-tested as adults. In contrast, reductions in event-related theta were seen in ketamine-exposed mice at both time points. CONCLUSIONS: Age related deficits in electrophysiological components such as P20 or event-related gamma may be due to an interruption of normal neural maturation. Reduction of NMDAR signaling during adolescence leads to delayed-onset disruption of gamma oscillations and the P20 component of the ERP. Further, delayed onset of impairment following adolescent ketamine abuse suggests that methods could be developed to detect and treat the early effects of drug exposure prior to the onset of disability.

The Endocannabinoid System as Pharmacological Target Derived from Its CNS Role in Energy Homeostasis and Reward. Applications in Eating Disorders and Addiction.

The endocannabinoid system (ECS) has been implicated in many physiological functions, including the regulation of appetite, food intake and energy balance, a crucial involvement in brain reward systems and a role in psychophysiological homeostasis (anxiety and stress responses). We first introduce this important regulatory system and chronicle what is known concerning the signal transduction pathways activated upon the binding of endogenous cannabinoid ligands to the Gi/0-coupled CB1 cannabinoid receptor, as well as its interactions with other hormones and neuromodulators which can modify endocannabinoid signaling in the brain. Anorexia nervosa (AN) and bulimia nervosa (BN) are severe and disabling psychiatric disorders, characterized by profound eating and weight alterations and body image disturbances. Since endocannabinoids modulate eating behavior, it is plausible that endocannabinoid genes may contribute to the biological vulnerability to these diseases. We present and discuss data suggesting an impaired endocannabinoid signaling in these eating disorders, including association of endocannabinoid components gene polymorphisms and altered CB1-receptor expression in AN and BN. Then we discuss recent findings that may provide new avenues for the identification of therapeutic strategies based on the endocannabinod system. In relation with its implications as a reward-related system, the endocannabinoid system is not only a target for cannabis but it also shows interactions with other drugs of abuse. On the other hand, there may be also a possibility to point to the ECS as a potential target for treatment of drug-abuse and addiction. Within this framework we will focus on enzymatic machinery involved in endocannabinoid inactivation (notably fatty acid amide hydrolase or FAAH) as a particularly interesting potential target. Since a deregulated endocannabinoid system may be also related to depression, anxiety and pain symptomatology accompanying drug-withdrawal states, this is an area of relevance to also explore adjuvant treatments for improving these adverse emotional reactions.